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General NPI Number Information
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NPI Number | 1477976082
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Entity Type | Individual
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Provider Name | CHARLES LUCKEY DUNN MD
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Gender | Male
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Dates
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Enumeration Date | 02/03/2014
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 1720 DUNLAWTON AVE STE 2
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City | PORT ORANGE
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State | FL
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Zip | 32127-2916
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Country | US
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Telephone | 866-400-3376
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Fax | 386-322-8370
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Provider Business Mailing Address
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Address Line | 151 SOUTHHALL LN STE 300
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City | MAITLAND
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State | FL
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Zip | 32751-7172
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Country | US
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Telephone | 866-400-3376
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Fax | 407-650-3455
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME150625
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | ME150625
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License Number State | FL
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